Time Is of the Essence: The Impact of Delayed Antibiotic Therapy on Patient Outcomes in Hospital-Onset Enterococcal Bloodstream Infections.
2016年 CIDに報告された、腸球菌菌血症に対するearly therapyとdelayed therapyを比較したretrospective observational cohort study。
- Time Is of the Essence: The Impact of Delayed Antibiotic Therapy on Patient Outcomes in Hospital-Onset Enterococcal Bloodstream Infections.
P : nonneutropenic patients with hospital-onset EBSI (enterococcal bloodstream infections)
E : early therapy
C : delayed therapy ≥48.1 hours
O : 30-day mortality was substantially increased (14.6% vs 45.3%; P < .001)
After adjustment for severity of illness and comorbidity, delayed therapy ≥48.1 hours was associated with a 3-fold increase in 30-day mortality (risk ratio, 3.16 [95% confidence interval, 1.96-5.09])
T : a single-center, retrospective observational cohort study
First, this was a retrospective study and the findings are subject to the caveats associated with this design. The primary concern is missing data due to incomplete documentation in the medical record. To address this, we selected objective, easily measureable outcomes, such as all-cause mortality and EBSI duration. Although some patients experiencing 30-day mortality following hospital discharge may have been missed, these missed outcomes would have been nondifferentially distributed between the early and delayed therapy groups, thus having little impact on the findings. This was an urban, single-center analysis restricted to adult, nonneutropenic patients with hospital-onset EBSI in an attempt to maximize internal validity in addressing our study question. As isolates were not collected, we were unable to complete genotypic testing to control for institution-specific strains. The high VRE prevalence is not reflective of all settings in the United States or worldwide. However, considering that increased mortality was associated with delayed therapy in both vancomycin-resistant and -susceptible infections, it appears the high VRE prevalence did not substantially influence these findings. Nonetheless, it is uncertain whether these results are directly applicable to other settings and populations, and further study is required to confirm these findings.